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Treatment of relapsed or refractory adult acute lymphocytic leukemia
Author(s) -
Freund Mathias,
Diedrich Helmut,
Gamer Arnold,
Gramatzki Martin,
Heil Gerhard,
Heyll Axel,
Henke Michael,
Hiddemann Wolfgang,
Haas Rainer,
Kuse Rolf,
Koch Peter,
Link Hartmut,
Maschmeyer Georg,
Plonker Manfred,
Queißier Wolfgang,
SchadeckGressel Claire,
Schmitz Norbert,
Verschuer Ulla Von,
Wilhelm Sibylla,
Thiel Eckhard,
Hoelzer Dieter
Publication year - 1992
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19920201)69:3<709::aid-cncr2820690318>3.0.co;2-g
Subject(s) - medicine , gastroenterology , refractory (planetary science) , cytarabine , surgery , etoposide , leukemia , acute lymphocytic leukemia , chemotherapy , physics , lymphoblastic leukemia , astrobiology
Sixty‐six adult patients were treated for relapsing or refractory acute lymphocytic leukemia (ALL). The induction treatment consisted in a (1) first phase with vindesine 3 mg/m 2 intravenously (IV) on days 1,8, and 15; daunorubicin 45 mg/m 2 IV on days 1, 8, and 15; erwinia‐asparaginase 10,000 U/m 2 IV on days 7, 8, 14, and 15; and prednisone 60 mg/m 2 orally on days 1 to 21 and a (2) second phase with cytarabine 3000 mg/m 2 as a 3‐hour infusion two times a day on days 1 to 4 (in patients > 50 years of age we used 1000 mg/m 2 ), and etoposide 100 mg/m 2 IV on days 1 to 5. Side effects of induction Phase I were predominantly hematologic with subsequent infections. In Phase II, some patients additionally had gastrointestinal, cutaneous, ocular, and hepatic toxicity. Five patients died during Phase I and another died during Phase II. Five of these patients had T‐cell ALL. Thirty‐four (64%) of 54 patients in their first relapse had a complete remission (CR) with a median disease‐free survival (DFS) of 2.9 months. The median overall survival (OAS) was 6.6 months. Seven of 12 patients with primary refractory disease, a second relapse, or relapse after bone marrow transplantation (BMT) had a CR. The CR rate and survival after first relapse was significantly better in patients with a preceding CR of more than 18 months compared with those with a shorter preceding remission. The leukocyte count was a second significant but not independent risk factor. There was a negative correlation between the leukocyte count and the duration of the preceding CR. The duration of the preceding CR was the major prognostic factor for survival in multivariate analysis. Twenty‐two patients received BMT. None of nine patients with autologous BMT is alive and disease‐free;5 of 13 who underwent allogeneic BMT are. It was concluded that this treatment efficiently induced remissions with tolerable toxicity. The remission duration should be improved by optimized consolidation treatment.